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Telehealth Urgent Care for Extremely Remote Locations
Session #186, February 13, 2019
Dr. Eduardo Cordioli, MD
General Manager
Telemedicine Center
Hospital Israelita Albert Einstein
Dr. Carlos Pedrotti, MD
Clinical Staff Supervisor
Telemedicine Center
Hospital Israelita Albert Einstein
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Dr. Eduardo Cordioli, MD
Has no real or apparent conflicts of interest to report.
Dr. Carlos Pedrotti, MD
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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Dr. Carlos Pedrotti
Review of literature
The case of Off-shore Oil & Gas platforms
How telemedicine may help offshore workers?
Dr. Eduardo Cordioli
How to set-up a telemedicine service on offshore platforms
What are the main challenges
Best practices protocols
Real-world data
Q/A
Agenda
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Define which are the most common urgent illnesses affecting
onboard offshore oil & gas platform personnel and quantify
effectiveness and safety of urgent care delivery by telemedicine
in that environment
Explain in detail disembarking due to acute illness protocols
and procedures taken by telemedicine physician to assure aircraft
and patient safety during transportation
Identify which advanced examination tools via telemedicine are
used most often, including otoscope, skin/eye/throat examination,
heart and lung auscultation, EKG and blood tests
Learning Objectives
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Telehealth for Extremely Remote Locations
Medical Literature Review
Extreme Remote Locations:
1. Strategic Military Bases
2. Space Program
3. Arctic regions and Antarctica
4. Offshore Environment***
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Telehealth for Extremely Remote Locations
Medical Literature Review
1. Strategic Military Bases
2. Space Program
3. Arctic Regions and Antarctica
Most remote military and Antarctic bases have physicians onsite
1,2,4
,
and telemedicine is mainstream for specialist consultation for
decades, considered highly successful and cost-effective
4-5.
Space
programs use telemedicine since 1957
3
.
[1] Sinderfin, CD. Telemedicine in the British Antarctic Survey Medical Unit. J Telem Telecare 1995.
[2] Ohno, G. Practical experience of telehealth between an Antarctic station and Japan. J Telem Telecare 2012.
[3] Doarn, CR. Applications of telemedicine in the United States space program. Telemed J. 1998
[4] Poropatich R. The U.S. Army Telemedicine and m-Health Program: Making a Difference at Home and Abroad. Telemedicine and E-Health 2013
[5] Grady, BJ. A Comparative Cost Analysis of an Integrated Military Telemental Health-Care Service. Telemedicine Journal and E-Health 2002
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Boultinghouse
,
OW 2013
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Videoconference
-
85%
Webster
, K 2008
2
Digital ECG
-
80%
[1] O.W. Boultingshouse, T.G.Jr. Fitts. Drilling Contractor, 2013.
[2] K. Webster, S. Fraser, F. Mair, J. Ferguson. Journal of Telemedicine and Telecare 2008:14:162-164.
Telehealth for Extremely Remote Locations
Medical Literature Review
4. Oil & gas Offshore Rigs:
Reduction of unnecessary Medical Evacuations using video-
based healthcare assessment and Digital ECG
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4. Oil & gas Offshore Rigs (cont):
Shorter response times and early initiation of treatment
in critical conditions
1,2,3,4,5
Increased patient satisfaction and perception of safety by
offshore personnel
3,6
The petroleum industry recognizes that there are still
potentials for improvement
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[1] A. Evensen, I. Fjaertoft. 2008.
[2] K. Webster, S. Fraser, F. Mair, J. Ferguson. Journal of Telemedicine and Telecare 2008:14:162-164.
[3] D.L. Anscombe, D. L. Health Care delivery for Oil Rig Workers: Telemedicine Plays a Vital Role. TELEMEDICINE and e-HEALTH, 16. 2010.
[4] F. Mika, V. Nicosia, E. Croitoru, R. Dalida, S. De Sanctis. Acta Informatica Medica 2009:17(3):155-160.
[5] W. Ponsonby, F. Mika, G. Irons. Occupational Medicine 2009:59(5):298303.
[6] F. Mair, S. Fraser, J. Ferguson, K. Webster, K. Journal of Telemedicine and Telecare 2008:14:129-131.
[5] K. Reegrd, et al. (Eds.), 2014.
Telehealth for Extremely Remote Locations
Medical Literature Review
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Case: Offshore Oil & Gas Platforms
Circa 1901 photo by G.H. Eldridge courtesy National Oceanic & Atmospheric Administration.
As recently as 1947 no company had ever
risked drilling beyond the sight of land.
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Worldwide Offshore Active Rigs
Brazil
31
Brazil
31
Venezuela
10
Venezuela
10
Gulf of Mexico
120
Gulf of Mexico
120
East
Africa 61
East
Africa 61
Mediterranean
23
Mediterranean
23
India
175
India
175
Australia
11
Australia
11
China
148
China
148
Japan
5
Japan
5
Southeastern
Asia 83
Southeastern
Asia 83
Middle
East 252
Middle
East 252
North Sea
114
North Sea
114
Canada
2
Canada
2
Source: Baker & Hughes Rig Count Nov 2018
Global 1044Global 1044
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What is life like on an oil rig?
Photograph by Mike Peel (www.mikepeel.net)
50-200 people onboard, many located
more than 100 miles offshore
2 weeks on / 2 weeks off, commute by
helicopter
12-hour shifts, intensive training
Shared bedrooms and bath, self-
service style canteen with food
prepared by a chef and dedicated staff
Gym, billiard table, pool, movie theatre,
computer room with wi-fi, Skype,
telephone (cellphones not allowed)
50-200 people onboard, many located
more than 100 miles offshore
2 weeks on / 2 weeks off, commute by
helicopter
12-hour shifts, intensive training
Shared bedrooms and bath, self-
service style canteen with food
prepared by a chef and dedicated staff
Gym, billiard table, pool, movie theatre,
computer room with wi-fi, Skype,
telephone (cellphones not allowed)
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Telemedicine on offshore rigs
Telemedicine is practiced using radio
communication since early offshore
drilling attempts
All offshore facilites need a trained
medic onboard
1
.
Telemedicine-based healthcare
assessment is common practice
Today use of videoconferencing and
digital medical devices is increasingly
being adopted.
Telemedicine is practiced using radio
communication since early offshore
drilling attempts
All offshore facilites need a trained
medic onboard
1
.
Telemedicine-based healthcare
assessment is common practice
Today use of videoconferencing and
digital medical devices is increasingly
being adopted.
Photograph by Mike Peel (www.mikepeel.net)
1. HSE Healthcare and first aid on offshore installations and pipeline works. Regulation 5(1). 1989
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Why Videoconferencing?
Verbal
7%
Vocal
38%
Facial
55%
Source: Mehrabian, 1981
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Telemedicine Setup
Integrated Software Platform
Health Information Management
Revised Care Protocols
Integrated Software Platform
Health Information Management
Revised Care Protocols
Equipped
Sickbay
Equipped
Sickbay
Trained
Onboard Medic
Trained
Onboard Medic
Broadband
Network
Broadband
Network
Telemedicine
Equipment
Telemedicine
Equipment
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Usual Workflow
Acute Health Condition
Telemedicine station at sickbay
(onboard trained medic)
Video consultation via teleheath
with certified medical doctor
Prescription/orientation
Resolution / Observation
Evacuation
Digital Audio
HD Video
EKG
POCT Tests
Oroscopy
Otoscopy
Skin Camera
Sthetoscope
Digital Audio
HD Video
EKG
POCT Tests
Oroscopy
Otoscopy
Skin Camera
Sthetoscope
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Best Practices
Health professionals training:
ACLS + pHTLS + ATLS
Offshore rescue training
Contents of medical chest
Use of telemedicine equipment and
backup plans
Health professionals training:
ACLS + pHTLS + ATLS
Offshore rescue training
Contents of medical chest
Use of telemedicine equipment and
backup plans
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Best Practices
Guidelines and Protocols:
International guidelines
Adjusted to offshore environment,
limitations and air evacuation
Attention to detailed reporting
Continuous communication to
occupational medicine doctors
Guidelines and Protocols:
International guidelines
Adjusted to offshore environment,
limitations and air evacuation
Attention to detailed reporting
Continuous communication to
occupational medicine doctors
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Best Practices
Network and technology:
HIPAA compliance
Network Redundance
Backup plans
Interoperability
Network Proactive Monitoring
Network and technology:
HIPAA compliance
Network Redundance
Backup plans
Interoperability
Network Proactive Monitoring
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Case Report
ST-Segment Elevation Myocardial
Infaction
Mortality Increases 7,5% every 30
minutes of treatment delay
Circulation. 2004 Mar 16; 109(10):1223-5.
MPS, 63 yo (2018-03-20)
Two hours of chest pain
Medicated under international
protocols and monitorized
continuously by telemedicine
cardiologist.
Evacuation delayed 4 hours due
to climate conditions
Cath-lab enabled destination
hospital selected
Underwent angioplasty onshore
and had a favourable prognosis
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Real World Data
2017
965
video visits
6,8% Evacuations
(71,4% Non-Urgent)
93,2%
Discharged
Hospital Israelita Albert Einstein Unpublished Data
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Real World Data
Hospital Israelita Albert Einstein Unpublished Data
28.2%
9.3%
6.5%
5.8%
4.5%
3.4%
3.3%
3.2%
3.0%
2.8%
28.5%
0%
5%
10%
15%
20%
25%
30%
Main Diagnosis
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Real World Data
Hospital Israelita Albert Einstein Unpublished Data
11.1%
9.5%
7.9%
6.3%
6.3%
4.8%
4.8%
4.8%
4.8%
4.8%
34.9%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Main Evac Diagnosis
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Medical Devices - Mainstream
Stethoscopes Exam Cameras
Vital SignsOtoscopes
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Medical Devices - Advanced
EKG Ultrasound
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Medical Devices - Example
Hospital Israelita Albert Einstein Personal Archive
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Medical Devices Real World
15.4%
5.5%
3.0%
2.2%
2.0%
1.9%
0.8%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Devices Utilization
(other than vitals)
Hospital Israelita Albert Einstein Unpublished Data
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Medical Devices The limits
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Take Home Messages
Adequate training of on/offshore health
professional is key
Need for special protocols for evacuation
Detailed reporting
Most common reasons for medical visits are
common common colds, headaches and AGEs
Most common medical device used is the exam
camera, and complex devices are rarely used, but
may be of great importance
Adequate training of on/offshore health
professional is key
Need for special protocols for evacuation
Detailed reporting
Most common reasons for medical visits are
common common colds, headaches and AGEs
Most common medical device used is the exam
camera, and complex devices are rarely used, but
may be of great importance
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Many thanks for your attention!
Please complete the online session evaluation
Questions
Dr. Eduardo Cordioli, MD
General Manager
Telemedicine Center
Hospital Israelita Albert Einstein
eduardo.cordioli@einstein.br
Dr. Carlos Pedrotti, MD
Clinical Staff Supervisor
Telemedicine Center
Hospital Israelita Albert Einstein
carlos.pedrotti@einstein.br
www.einstein.br/en